Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | M7891 | ID |
NPI | 1043249964 |
---|---|
Provider Name | Martha A Cline |
First Address | Meridian, ID 83642 |
Second Address | Meridian, ID 83642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 12/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003621300 | (05) | ID |
C92404 | (02) | |
M7891 | STATE LICENSE # (01) | ID |